arsenic trioxide and cholecalciferol (vitamin d) in treating patients with myelodysplastic syndromes

Conditions: Leukemia; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms

Summary: rationale: drugs used in chemotherapy, such as arsenic trioxide, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. cholecalciferol (vitamin d) may help cancer cells become normal cells. giving arsenic trioxide together with cholecalciferol (vitamin d) may kill more cancer cells. purpose: this phase ii trial is studying how well giving arsenic trioxide together with cholecalciferol (vitamin d) works in treating patients with myelodysplastic syndromes.

objectives: primary * determine the complete response rate and the rate of hematological improvement in patients with myelodysplastic syndromes treated with arsenic trioxide and cholecalciferol (vitamin d). secondary * determine the safety of this regimen in these patients. * determine the time to progression to acute myeloid leukemia, defined as blast ≥ 20%, in patients treated with this regimen. * determine overall survival and progression-free survival of patients treated with this regimen. * determine the effect of this regimen on bone marrow and peripheral blood mononuclear cell apoptosis and p21 protein expression in these patients. outline: this is an open-label, nonrandomized study. patients receive oral cholecalciferol (vitamin d)\* once daily on days 1-28. patients also receive arsenic trioxide iv over 1-4 hours on days 1-5 (week 1) and then twice weekly for 3 weeks (weeks 2-4) for course 1 and twice weekly for 4 weeks for all subsequent courses. courses repeat every 28 days for up to 12 months in the absence of disease progression or unacceptable toxicity. note: \* patients who do not achieve a complete hematologic response receive escalating doses of cholecalciferol (vitamin d) at 3, 6, and 9 months during therapy in the absence of disease progression and unacceptable toxicity. at the completion of study treatment, patients are followed for survival. projected accrual: a total of 25-60 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: * diagnosis of myelodysplastic syndromes (mds) * bone marrow aspirate and biopsy with karyotyping performed within the past 12 weeks patient characteristics: age * any age performance status * ecog 0-2 life expectancy * more than 6 months hematopoietic * ferritin ≥ 50 ng/ml * folate (serum and/or red blood cell) normal hepatic * not specified renal * creatinine \< 2.0 mg/dl * no history of hypercalcemia cardiovascular * absolute qt interval ≤ 460 msec by ekg with normal potassium and magnesium levels other * not pregnant or nursing * negative pregnancy test * fertile patients must use effective contraception during and for 2 weeks after study participation * serum vitamin b_12 normal prior concurrent therapy: biologic therapy * prior biologic therapy allowed * more than 28 days since prior hematopoietic growth factors (e.g., filgrastim \[g-csf\], sargramostim \[gm-csf\], or epoetin alfa) for mds * no concurrent hematopoietic growth factors (e.g., g-csf, gm-csf, or epoetin alfa) * no concurrent interleukin-11 chemotherapy * prior chemotherapy allowed endocrine therapy * not specified radiotherapy * prior radiotherapy allowed surgery * not specified other * more than 28 days since prior therapy for mds except supportive therapy * no concurrent cholecalciferol (vitamin d) analog, including topical therapy * no concurrent vitamins or supplements containing cholecalciferol (vitamin d) * no other concurrent therapy for mds

Keywords: de novo myelodysplastic syndromes myelodysplastic/myeloproliferative neoplasm, unclassifiable previously treated myelodysplastic syndromes secondary myelodysplastic syndromes refractory anemia with excess blasts in transformation refractory anemia with excess blasts refractory anemia refractory anemia with ringed sideroblasts refractory cytopenia with multilineage dysplasia chronic myelomonocytic leukemia childhood myelodysplastic syndromes